Lamy Olivier, Gonzalez Rodriguez Elena, Stoll Delphine, Aubry-Rozier Bérengère, Livio Françoise
1 Service de Médecine Interne et Centre des Maladies Osseuses, Départements de Médecine et de l'Appareil Locomoteur - CHUV, Lausanne.
2 Service d'Endocrinologie, Diabétologie et Métabolisme et Centre des Maladies Osseuses, Départements de Médecine et de l'Appareil Locomoteur - CHUV, Lausanne.
Praxis (Bern 1994). 2018 Jun;107(12):649-654. doi: 10.1024/1661-8157/a002997.
Multiple Vertebral Fractures after Denosumab Discontinuation: How to Avoid Them? Abstract. Denosumab is a monoclonal antibody raised against the RANK ligand that inhibits the maturation and activity of osteoclasts. It decreases bone resorption, increases bone density and reduces fracture risk. However, after its discontinuation, a significant rebound effect appears that lasts about two years. It results in increased markers of bone remodeling, a loss of bone density that may be greater than gain, and an increased risk of multiple vertebral fractures. These fractures occur at a frequency of 1 to 10 %. Due to this high risk, denosumab should be a second-line treatment limited to very specific indications. At denosumab discontinuation, in order to limit the rebound effect, the current recommendation is to prescribe a strong bisphosphonate (alendronate, zoledronate) and regularly monitor the bone resorption markers.
如何避免？摘要。地诺单抗是一种抗核因子κB受体活化因子配体（RANKL）的单克隆抗体，可抑制破骨细胞的成熟和活性。它能减少骨吸收，增加骨密度并降低骨折风险。然而，停药后会出现持续约两年的显著反弹效应。这会导致骨重塑标志物增加、骨密度丢失（可能大于增加量）以及多发椎体骨折风险增加。这些骨折的发生率为1%至10%。鉴于这种高风险，地诺单抗应作为仅限于非常特定适应症的二线治疗药物。在地诺单抗停药时，为限制反弹效应，目前的建议是开具强效双膦酸盐（阿仑膦酸钠、唑来膦酸）并定期监测骨吸收标志物。
